title: Vigilance, awareness and a phone line: 20 years of expediting CPR for enhancing survival after out-of-hospital cardiac arrest. The 'SHL'-Telemedicine experience in Israel.
abstract: OBJECTIVE
  The only large-scale report (1988) by the Israeli national ambulance service Magen David Adom (MDA) on the outcome of cardiac arrest victims who underwent cardiopulmonary resuscitation (CPR) by paramedics called for more frequent and more promptly initiated CPR and shorter time to arrival of paramedic care to improve survival. We report the 1987-2007 experience of resuscitation of out-of-hospital cardiac arrest victims who were 'SHL'-Telemedicine subscribers and who underwent CPR by SHL-Telemedicine mobile intensive care units (MICUs) personnel or under their instructions.
  
  
  METHODS
  'SHL's records of MICU reports and specifics of CPR maneuvers and outcome of resuscitated patients, as recorded by its MICU physicians, were analyzed to determine whether the system enhanced survival.
  
  
  RESULTS
  A total of 1810 'SHL'-Telemedicine subscribers (mean age 76+/-12 years [16-104], 67% males) were resuscitated after cardiac arrest, 597 (33%) were hospitalized and 279 (15.4%) were discharged alive. Factors associated with successful resuscitation included witnessed collapse and documented ventricular fibrillation upon MICU arrival. A history of diabetes, hyperlipidemia, stroke or advanced age adversely affected the outcome. Time from collapse to CPR initiation and duration of CPR correlated significantly with survival. Laymen instructed telephonically by the 'SHL'-Telemedicine center performed CPR on 121 patients: 13 (10%) survived to hospital discharge.
  
  
  CONCLUSIONS
  'SHL'-Telemedicine's policy of bi-monthly contact with its subscribers led to heightened awareness of warning signs and need for rapid summoning of medical assistance in the setting of out-of-hospital sudden cardiac arrest.
authors.affiliation: Department of Internal Medicine B, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Edo Y
authors.initials: EY
authors.lastname: Birati
authors.forename: Nomi
authors.initials: N
authors.lastname: Malov
authors.forename: Yevgeni
authors.initials: Y
authors.lastname: Kogan
authors.forename: Yigal
authors.initials: Y
authors.lastname: Yanay
authors.forename: Mira
authors.initials: M
authors.lastname: Tamari
authors.forename: Mayera
authors.initials: M
authors.lastname: Elizur
authors.forename: David M
authors.initials: DM
authors.lastname: Steinberg
authors.forename: Michal
authors.initials: M
authors.lastname: Golovner
authors.forename: Arie
authors.initials: A
authors.lastname: Roth
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D015897:Comorbidity; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D017216:Telemedicine / Q000379:methods*